MO HB821

Requires electronic prescription systems to display patient medication history, allow electronic prior authorization with 48-hour adjudication, and use neutral platforms without favoring brand medications over generics.

Prohibits pharmacy benefit managers from automatically enrolling pharmacies in contracts, requiring participation in one contract to join another, or discriminating between in-network pharmacies based on copayments or days of supply.

Requires switch communications (recommendations to change medications) to disclose original and proposed medications, financial incentives to prescribers, clinical differences, cost-sharing changes, and net cost changes to insurers.

Mandates health carriers and PBMs submit switch communications to the Department of Insurance for approval within 60 days and establishes penalties up to $25,000 for noncompliant or false switch communications.

Requires step therapy and fail-first protocols to allow prescriber override when preferred treatment is ineffective or likely harmful, with durations limited to 14 days extendable to 21 days with clinical justification.